Healthcare Provider Details

I. General information

NPI: 1902810757
Provider Name (Legal Business Name): MOUNTAIN WEST OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 N COLLEGE RD
TWIN FALLS ID
83301
US

IV. Provider business mailing address

731 N COLLEGE RD
TWIN FALLS ID
83301-3382
US

V. Phone/Fax

Practice location:
  • Phone: 208-734-3937
  • Fax: 208-734-7585
Mailing address:
  • Phone: 208-734-3937
  • Fax: 208-734-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: SHIRLENE TRANMER
Title or Position: ADMINISTRATOR
Credential:
Phone: 208-734-3937